In a technology-driven world, healthcare is undergoing a significant transformation. Innovations such as telemedicine, artificial intelligence, and virtual reality are reshaping care delivery, making it more accessible, affordable, and efficient. At the core of this shift lie interoperable electronic health records (EHRs), which unify critical patient data – including diagnoses, prescriptions, treatment histories, X-rays, and lab results – across providers. Designed to address diverse needs, EHRs promise better care quality and improved health outcomes.
India’s healthcare landscape, often marked by fragmentation, is poised for transformation through the Ayushman Bharat Digital Mission (ABDM). With the introduction of the Ayushman Bharat Health Account (ABHA), a unique 14-digit identifier, patients’ health data can be securely accessed across platforms with their consent. This patient-centric approach ensures portability and universal access while prioritizing privacy through consent–based data sharing.
Interoperable healthcare
Imagine this: A patient in suburban Bengaluru visits a nearby clinic for a routine health checkup. The doctor, suspecting diabetes based on the patient’s symptoms, prescribes initial tests as well as some medications. With a personal health record application on their phone (similar to a UPI app), the patient seamlessly shares their information and prescription with the diagnostic lab, ensuring that the tests are accurate. Once the results are available, they can be instantly linked to the patient’s ABHA and shared further with the patient’s consent. Later, during follow–up teleconsultations, the healthcare provider reviews the test reports in real-time, confirming the diagnosis and creating a personalised treatment plan for the patient. Even a visit to the pharmacy becomes streamlined as the pharmacist accesses the prescriptions through ABDM’s interoperable system with the patient’s authorisation.
This vision is becoming a reality. Over 737 million individuals have created ABHAs, and more than 61,000 health facilities actively link health records (National Health Authority, accessed on 27 January 2025). With over 485 million health records already linked in the ABDM ecosystem, the potential for seamless healthcare delivery is immense.
Despite these advancements, patients still carry bulky files that can be misplaced or incomplete, disrupting continuity of care. In urban and semi-urban areas, an estimated two-thirds of patients still depend on paper records, underscoring the urgent need for digital transformation (Centre for Social and Behaviour Change, 2024).
Interoperable health systems can eliminate such inefficiencies, enabling consistent and comprehensive record-keeping, accessible anywhere. For vulnerable populations, such as migrants and rural residents, this ensures equitable access to quality care. Corporate Social Responsibility (CSR) initiatives can amplify these efforts, bridging the gap between technology and access through digital infrastructure investments and awareness campaigns.
Benefits for stakeholders
Interoperable health records are life-changing for patients. By linking their health history to an ABHA, they gain autonomy over their healthcare journey. Features like ABDM’s “Scan & Share” simplify processes like booking appointments, check-ins, and consultations. Patients no longer need to repeatedly narrate their medical history or worry about lost prescriptions, enhancing their overall healthcare experience.
Healthcare providers, meanwhile, have real-time access to comprehensive patient data enabling informed decision-making, reducing medical errors, and streamlining workflows. By minimising administrative burden, providers can focus on delivering quality care. Additionally, instant access to complete medical histories can be lifesaving in emergencies.
From a business perspective, the economic and social value of interoperable systems is undeniable. The National Health Claims Exchange innovates processes and facilitates efficient insurance claims, reducing costs and processing times. Further, interoperable records can enable predictive analytics, helping insurers and providers anticipate patient needs, design policies, and allocate resources effectively.
Further, anonymised health data generated through these systems holds immense potential for research and medical advancements. Aggregated data can reveal disease patterns, evaluate treatment outcomes, and develop targeted interventions. For instance, large-scale data analysis can accelerate drug discovery, improve early detection algorithms, and optimise resource allocation during public health emergencies. By harnessing this data, India can address pressing healthcare challenges while driving global medical innovation.
Resilient future
Interoperable health records form the backbone of a responsive healthcare system. In India, they enable agile responses to crises like Covid-19 and bolster preparedness for future challenges. Consider rural clinics, mobile medical units, and urban hospitals sharing critical patient data seamlessly to ensure uninterrupted care. This integration can significantly enhance the inclusivity and efficiency of healthcare delivery.
Businesses, CSR organisations, and philanthropies play a pivotal role in this journey. Beyond funding, they can provide technological expertise and support the government in developing solutions tailored to India’s unique needs. By championing interoperable systems, these entities not only create a healthier society but also position themselves as catalysts of India’s digital health revolution.
(This is the second article in a six-part series exploring the importance of digital health in India)
Successful interoperability in India’s healthcare system hinges on governance, regulatory frameworks and understanding diverse regional needs, says Sameer Kanwar (director, digital health, India & South Asia, PATH). He shares his insights on how ABDM’s interoperability enhances patient care, the challenges to its adoption and the critical role of governance in India’s healthcare transformation
How does ABDM’s interoperability benefit patients and providers?
Interoperability benefits both patients and providers by ensuring continuity of care, especially in common scenarios. For instance, a pregnant woman relocating for delivery might have undergone antenatal checkups, ultrasounds, and diagnostics elsewhere. Without interoperability, these records may remain siloed, leading to missed information or redundant tests if records are lost or not manually carried. Interoperability enables doctors in the new location to access her complete medical history, helping identify critical details like high-risk pregnancy indicators or past treatments, strengthening decision-making and improving care quality. It also reduces out-of-pocket expenses, avoids unnecessary tests, and enhances system efficiency by saving doctors’ time, allowing them to see more patients. Overall, interoperability creates a more effective, patient–centric healthcare ecosystem.
What key factors drive successful interoperability across different types of healthcare facilities?
Successfully implementing interoperability across clinics, hospitals, labs, and pharmacies requires more than technology – governance, policy, and regulatory frameworks are foundational. While standards like HL7 and tools like the ABDM Sandbox are important, they are the easier part. The real challenge lies in structuring systems for interoperability through strong governance and cohesive regulations.
Key factors include ensuring private sector compliance, integrating digital health governance, and engaging private healthcare providers, who form a significant part of India’s healthcare ecosystem. Citizen engagement is also crucial – demonstrating tangible value, as seen in digital payments, drives adoption. Finally, the system must adapt to growing compliance demands as more players join the digital health space, ensuring efficient onboarding.
What strategies effectively showcase the value of interoperability, and how has on-ground support aided provider adoption?
Demonstrating interoperability’s value requires targeted strategies, practical examples, and strong on-ground support. One effective approach is the National Health Authority’s (NHA) Digital Health Incentive Scheme, which pays Rs20 per linked digital health record to health facilities and R5 per record to ABDM-enabled solution providers. This boosted adoption by nearly 50 per cent, proving the impact of such incentives. On-ground engagement, including advocacy with doctor associations and clinic staff handling operations like triaging, has further eased adoption.
Another key initiative, “Scan & Share,” piloted at Lady Hardinge Medical College and Smt. Sucheta Kriplani Hospital in New Delhi, improved patient information accuracy and cut registration time from two hours to minutes, benefiting both patients and staff. Larger efforts, like the 100 microsites project for small facilities (clinics, labs, and pharmacies) and the 100 model facilities project for medium–large hospitals, are essential to scaling interoperability.
The real challenge lies in structuring systems for interoperability through strong governance and cohesive regulations
What are the key challenges to interoperability in India, and what support is needed for long-term ABDM adoption?
While technology is one of the hurdles, governance mechanisms are what will drive interoperability forward. A dedicated body, like TRAI in telecom or RBI in banking, is crucial for aligning stakeholders and ensuring seamless collaboration. Just as TRAI enabled mobile number portability and nationwide connectivity, a similar entity could unify efforts under a shared framework.
India has the necessary digital infrastructure, but ongoing dialogue with private hospitals and other players is essential for ABDM adoption. Demonstrating interoperability’s benefits – such as smoother registrations and coordinated care – will boost citizen engagement. Once users experience these advantages, adoption will follow naturally, as seen with Aadhaar and digital payments.
Do you have any additional insights from your experience with interoperable systems?
Healthcare in India spans diverse intersections – rural-urban, public-private, and varying societal tiers – each requiring tailored digitization approaches. Sustainable adoption of interoperability depends on understanding these differences, contextualizing use cases, and applying appropriate strategies to drive effective transformation.